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Enhancing Pediatric Suicide Risk Detection: Effective Screening, Pathways and Care

Enhancing Pediatric Suicide Risk Detection: Effective Screening, Pathways and Care 1024 683 Madison Storm

Youth suicide is a leading cause of death in the United States. Most youth who die by suicide have no mental illness diagnosis and have visited a health care provider within a year prior to their death. In fact, 40% of those youth visited a health care provider within one month prior.  

“The data indicates youth are unlikely to independently disclose thoughts of suicide unless directly asked,” says Jeffrey Bridge, PhD, suicide epidemiologist and director of the Center for Suicide Prevention and Research at Nationwide Children’s Hospital. “We know that asking about suicide does not ‘put the idea in a young person’s head’ or cause harm. In fact, it could save a life.”    

Screening Tools and Implementation Pathways  

Evidence-based screening tools with standardized questions are used by clinicians to help identify youth at risk for suicidal thoughts and behaviors. Common screening tools include:  

  • Ask Suicide-Screening Questions (ASQ) 
  • Computerized Adaptive Screen for Suicidal Youth (CASSY) 
  • Columbia-Suicide Severity Rating Scale (C-SSRS) 
  • Suicidal Behaviors Questionnaire (SBQ) 

The ASQ and CASSY are particularly promising for integration into medical settings due to their strong test accuracy. The American Academy of Pediatrics (AAP) released the Blueprint for Youth Suicide Prevention, an online resource providing evidence-based tools and guidance for integrating prevention strategies in youth treatment settings. The Blueprint details a three-tiered clinical pathway for screening and assessing suicide risk, with recommendations for adaptation to fit the setting’s culture. 

“Screening is challenging because of all the things competing for the clinician’s time during an encounter, whether it’s a primary care, specialist or emergency department visit,” says Dr. Bridge. “Evidence-based pathways can guide clinicians through the suicide risk screening, assessment, and disposition processes without overburdening their busy practices.” 

Interventions in Response to Suicide Risk 

If screening does indicate risk, clinicians can implement several standard interventions, including: 

  • Safety planning: a written list of coping strategies and support sources  
  • Lethal means safety counseling: educating patients and families about lethal means access, such as secure storage of firearms and medications  
  • Caring contacts:   a series of personalized contacts with patients either in-person or virtually 
  • Suicide prevention lifeline numbers: ensures access to immediate mental health support  

 “Research shows implementation of these interventions is feasible across pediatric health care settings, and Nationwide Children’s is a great example of this” says Dr. Bridge. “The Center for Suicide Prevention and Research supports youth-serving community organizations in Ohio in implementing sustainable and effective prevention programs.” 

Screening for Everyone, Everywhere  

Universal suicide risk screening supports health equity by giving every child a chance at intervention if indicated. However, some unique patient populations may need more customized screening tools. 

Suicide risk screening tools have not yet been developed specifically for pediatric patients with intellectual disabilities, but they are needed. For example, research shows clinicians feel lower self-efficacy to screen individuals with autism compared to individuals without autism due to lack of validated screening tools.  

Non-English-speaking patient populations require translated screening tools. To aid these efforts, many existing screening tools have been translated, and some have been validated in other languages.  

Significant progress in feasible suicide risk screening has been made within the last two decades, but research continues to play a vital role in continual improvement. In preteens and younger children for instance, research suggests suicidal thoughts and behaviors are becoming more prevalent, but limited research on child suicide makes advancements in screening tools difficult.  

The Future of Suicide Screening in Pediatrics 

Screening tools continue to evolve, with innovative approaches including: 

  • Implicit association tests (which measure automatic preferences, biases, and attitudes) 
  • Smart phones and wearable technology 
  • Machine learning 

Suicide risk screening tools guide health care professions in starting important conversations with youth. Continued research is necessary to advance these tools and their impact on pediatric patients. 

By using evidence-based screening tools and clinical pathways, embedding suicide prevention strategies in all health care settings is feasible and can help save lives.  

About the author

Senior Strategist, Research Communications | Website

Madison Storm is the Senior Strategist of Research Communications at Nationwide Children's Hospital. She earned her bachelor's in multimedia journalism from Virginia Tech in 2021 and went on to achieve her master's in health communication from Johns Hopkins University in 2023. Her passion for transforming the complex to clear is supported by various experiences writing for consumer audiences.

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